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PubMed1998

[Prescriptions of low therapeutic value imposed on primary care].

OBJECTIVES: 1. To quantify the percentage of prescriptions of low therapeutic value, and the associated pharmaceutical expenditure, which the specialist incurs for the general practitioner. 2. To determine which are the therapeutic groups of low therapeutic value most often delegated in this way, and so determine the profile of the specialists who recommend most medication with insufficient benefits. DESIGN: A descriptive, crossover, prospective study based on all the prescriptions of the month of March (21 days) to 4156 patients from the town of Es Castell (5720 inhabitants), Menorca. MATERIAL AND METHODS: The variables to be evaluated were defined and classified in scales. They included prescription, packages, working age/pensioner, origin (General Practitioner, Specialist, Private, Emergency), cost of the prescription, specialties broken down into anatomical-therapeutic groups, whether it was chronic or acute medication, and whether it was of high or low therapeutic value. RESULTS: Of the 3599 packages prescribed, 1993 were generated from outside the PC practice (55.3%). Of the 6069411 pesetas of expenditure in the period studied, 38.5% was due to general practitioners, 59.1% specialists, and 2.3% emergency services. 12.7% (456) of the packages prescribed were of low therapeutic value, of which 52.6% corresponded to the general practitioners' prescriptions, 45.6% to the specialists' and 4.5% to private practice. However, of the 523224 pesetas of expenditure, 62% was for specialists' prescriptions and only 36% for the general practitioners'. On comparing the profiles of prescriptions of low therapeutic value coming from specialists and direct from Primary Care, differences were found. The "cardiovascular" group accounted for 40.9% of specialist prescriptions and only 11.3% of G.P. ones; "central nervous system" (psychiatry, neurology) accounted for 24.5% and 12.1%, respectively. "Respiratory", however, was the opposite: 3.8% specialist and 25% G.P. Similarly the "others" category and 18.8% for specialists against 37.1% for G.P.s. CONCLUSIONS: It can be inferred that there is shared responsibility in the public health system between specialists and G.P.s for prescribing products of low therapeutic value. However, since the medication that specialists prescribe is dearer, they cause more expenditure than the packages of low therapeutic value, which they delegate to G.P.s.

Cross-Over Studies↗
PubMed2005

Generating signals of drug-adverse effects from prescription databases and application to the risk of arrhythmia associated with antibacterials.

BACKGROUND: Although it is well known that a variety of antibacterials may incidentally cause malignant arrhythmia, the list of drugs causing arrhythmia and the impact of these adverse effects are still uncertain. We investigated on this topic by using a large prescription database with different observational designs. METHODS: Prescription data on all incident users of several antibacterial and antiarrhythmic drugs over the period July 1997 through December 1999 were retrieved from the Drug Prescription Database (DPD) of the Italian Province of Varese. The association between the use of antibacterial and antiarrhythmic drugs was investigated by applying prescription sequence symmetry, cohort and nested case-control designs. RESULTS: Lower proarrhythmic effects were on an average obtained from prescription sequence symmetry approach with respect to both cohort and nested case-control. Evidence of association between exposure to drugs (erythromycin and ciprofloxacin) and the risk of arrhythmia was consistently found by the three approaches. No other signals were generated from the prescription sequence symmetry analysis. Two drugs (clarithromycin and levofloxacin) showed patterns compatible with an arrhythmic effect according to both cohort and nested case-control designs. CONCLUSIONS: Prescription databases are useful tools to explore drug safety through both conventional and emerging observational designs. In spite of its appealing features, prescription sequence symmetry design shows lower sensitivity with respect to conventional designs. Evidence about the association between the use of certain macrolides and fluoroquinolones and the onset of arrhythmia is confirmed by this study.

Adverse Drug Reaction Reporting Systems↗
PubMed1994

A multileaf collimator field prescription preparation system for conventional radiotherapy.

PURPOSE: The purpose of this work is to develop a prescription preparation system for efficient field shaping using a multileaf collimator that can be used in community settings as well as research institutions. The efficiency advantage of the computer-controlled multileaf collimator, over cerrobend blocks, to shape radiation fields has been shown in conformal treatments, which typically require complete volumetric computerized tomographic data for three-dimensional radiation treatment planning--a utility not readily available to the general community. As a result, most patients today are treated with conventional radiation therapy. Therefore, we believe that it is very important to fully use the same efficiency advantage of multileaf collimator as a block replacement in conventional practice. METHODS AND MATERIAL: The multileaf collimator prescription preparation systems developed by us acquires prescription images from different sources, including film scanner, and radiation treatment planning systems. The multileaf collimator angle and leaf positions are set from the desired field contour defined on the prescription image, by minimizing the area discrepancies. Interactive graphical tools include manual adjustment of collimator angle and leaf positions, and definition of portions of the field edges that require maximal conformation. Data files of the final leaf positions are transferred to the multileaf collimator controller via a dedicated communication link. RESULTS: We have implemented the field prescription preparation system and a network model for integrating the multileaf collimator and other radiotherapy modalities for routine treatments. For routine plan evaluation, isodose contours measured with film in solid water phantom at prescription depth are overlaid on the prescription image. Preliminary study indicates that the efficiency advantage of the MLC over cerrobend blocks in conformal therapy also holds true for conventional treatments. CONCLUSION: Our model of computer-controlled prescription, evaluation, and treatment using multileaf collimators can be effectively implemented in both community settings and research institutions. The resultant increase in treatment efficiency and accuracy is now available for conventional radiotherapy.

Humans↗
PubMed1995

A multileaf collimator field prescription preparation system for conventional radiotherapy.

PURPOSE: The purpose of this work is to develop a prescription preparation system for efficient field shaping using a multileaf collimator that can be used in community settings as well as research institutions. The efficiency advantage of the computer-controlled multileaf collimator, over cerrobend blocks, to shape radiation fields has been shown in conformal treatments, which typically require complete volumetric computerized tomographic data for three-dimensional radiation treatment planning--a utility not readily available to the general community. As a result, most patients today are treated with conventional radiation therapy. Therefore, we believe that it is very important to fully use the same efficiency advantage of multileaf collimator as a block replacement in conventional practice. METHODS AND MATERIAL: The multileaf collimator prescription preparation system developed by us acquires prescription images from different sources, including film scanner and radiation treatment planning systems. The multileaf collimator angle and leaf positions are set from the desired field contour defined on the prescription image, by minimizing the area discrepancies. Interactive graphical tools include manual adjustment of collimator angle and leaf positions, and definition of portions of the field edges that require maximal conformation. Data files of the final leaf positions are transferred to the multileaf collimator controller via a dedicated communication link. RESULTS: We have implemented the field prescription preparation system and a network model for integrating the multileaf collimator and other radiotherapy modalities for routine treatments. For routine plan evaluation, isodose contours measured with film in solid water phantom at prescription depth are overlaid on the prescription image. Preliminary study indicates that the efficiency advantage of the MLC over cerrobend blocks in conformal therapy also holds true for conventional treatments. CONCLUSION: Our model of computer-controlled prescription, evaluation, and treatment using multileaf collimators can be effectively implemented in both community settings and research institutions. The resultant increase in treatment efficiency and accuracy is now available for conventional radiotherapy.

Equipment Design↗
PubMed2005

Sources of prescription drugs for illicit use.

OBJECTIVES: This exploratory study investigated the sources of four classes of abusable prescription medications (sleeping, sedative/anxiety, stimulant, and pain medications) that were used illicitly by undergraduate students in the past year. The relationship between these sources and other substance use was examined. METHODS: In the spring of 2003, a random sample of 9,161 undergraduate students attending a large public Midwestern research university was selected to self-administer a Web-based survey. RESULTS: The respondents identified 18 sources of prescription drugs that were classified into three broad categories: peer, family, and other sources. The majority of respondents who were illicit users obtained their prescription drugs from peer sources. Undergraduate students who obtained prescription medication from peer sources reported significantly higher rates of alcohol and other drug use than students who did not use prescription drugs illicitly or students who obtained prescription medication from family sources. CONCLUSIONS: The findings of the present study offer strong evidence that undergraduate students obtain abusable prescription drugs from their peers. Greater prevention efforts are needed to reduce the illicit use and diversion of prescription medication.

Adolescent↗
PubMed2004

Relation of sex, age and concomitant diseases to drug prescription for heart failure in primary care in Europe.

AIM: To study the role of sex, age and concomitant diseases for prescription of cardiovascular drugs among patients with heart failure cared for in the community. METHODS AND RESULTS: In 15 European countries, a survey was conducted during 1999 and 2000 among 1363 primary care physicians who included 8256 patients with symptoms of heart failure. Predictors of drug prescription were assessed with multivariate logistic regression. Overall prescription rates for ACE-inhibitors/angiotensin receptor blockers (ACE-I/ARB), beta-blockers, digitalis, diuretics and oral anticoagulants were 69%, 30%, 41%, 75% and 18%. Women had no reduced likelihood to receive ACE-I/ARB and beta-blockers (odds ratio [OR]=0.96 [95% CI 0.87-1.06] and 1.02 [0.92-1.13], respectively), but prescription of oral anticoagulants was decreased (OR=0.74, 95% CI 0.65-0.84). Compared to patients <65 years of age, ACE-I/ARB prescription did not materially decline up to 75-85 years (R=0.91, 95% CI 0.81-1.04), whereas beta-blocker prescription was already significantly decreased in this age category (OR=0.49, 95% CI 0.43-0.56). There was no general under-prescription of evidence-based cardiovascular drugs in patients with concomitant diseases. CONCLUSIONS: Among heart failure patients cared for in the community advanced age strongly predicts decreased prescription of beta-blockers. Female sex and comorbidity is not associated with a consistent underutilization of evidence-based cardiovascular drugs.

Aged↗
PubMed2000

Mucosal dose prescription in endobronchial brachytherapy: a study based on CT-dosimetry.

PURPOSE: To investigate the consequences of using different dose prescription methods for endobronchial brachytherapy (EB), both with and without the use of a centered applicator. MATERIALS AND METHODS: A CT scan was performed during EB procedures in 13 patients after insertion of the lung applicator. A dosimetric analysis was subsequently performed in five of these patients using a 3D-brachytherapy treatment planning system (PLATO v13.3, Nucletron). RESULTS: Dose prescription to the mucosa yields uniform dose distributions to the bronchial mucosa when a centrally positioned applicator is used. When non-centrally positioned applicators are used, mucosal dosing results in a significant underdosage to parts of the target volume. Due to the rapid dose fall-off in EB, dose prescription to the mucosa resulted in inadequate coverage of the outer portion of the bronchial wall and adjacent peribronchial space. When compared to mucosal dose prescription, prescription to the outer aspect of the bronchial wall appears to improve target coverage while limiting the hyperdose (i.e., 200%) volume. The diameters of the different bronchial segments, as determined by CT measurements in 13 patients, correlated well with calculated values based upon the tracheal diameter. CONCLUSIONS: Mucosal dose prescription should only be used in combination with centered EB applicators. Given the rapid dose fall-off in EB mucosal dose prescription should be used with caution in curative treatments where EB, without additional external radiotherapy, is used as the sole treatment modality. In curative EB, both improved target coverage and a limited hyperdose volume can be achieved by dose prescription to the outer aspect of the bronchial wall.

Brachytherapy↗
PubMedDate not supplied

Progressive increases in peritoneal dialysis prescription: patient acceptance and complication rates.

Peritoneal dialysis adequacy has an impact on patient mortality. Both the CANUSA study and DOQI Guidelines outline targets for adequacy, and it has been suggested that quantitative adequacy determinations be made at regular intervals. Some groups believe these targets are not achievable because of lack of patient acceptance and high complication rate. We examined the outcome of peritoneal dialysis in a setting where prescription changes are made on clinical grounds, and determined the complication rates and patient acceptance of prescription changes. A total of 154 patients commencing peritoneal dialysis from January 1, 1994,-December 31, 1996, were studied to determine reasons for dialysis prescription changes, patient acceptance of, and complications related to these changes. Point prevalence data for dialysis prescription for our center and other Canadian centers were obtained from the Canadian Institute for Health Information. Co-morbidity - adjusted patient and technique survival for our center versus other centers in Canada was performed by Poisson regression analysis. Dialysis prescription changes were based on clinical assessment. A total of 102 patients started on either > 8 L of dialysate or had an increase in dialysis prescription during the study period. These patients were heavier, on peritoneal dialysis for longer, and fewer were transplanted compared with the patients on standard prescription (8 L or less). Only 4% of patients refused the change in dialysis prescription, and only 13 peritoneal leaks occurred, resulting in 3 transfers to hemodialysis. Our center prescribed a larger number of exchanges than other Canadian centers in 1995-1997. Adjusted mortality rate ratios for our center versus the other Canadian Centers (1990-1996) are equal. The 3 year technique survival for peritoneal dialysis patients from our center between 1990-1996 was 75% vs. 61% for other centers in Canada. At last follow-up, > 60% of patients had a Kt/V urea >2.1 and 45% had a creatinine clearance > 70 L/1.73 m2/week. This Regional Program has successfully prescribed high volume and frequency peritoneal dialysis on clinical grounds alone. This practice is associated with high patient acceptance, equivalent mortality, and higher technique survival compared with the rest of Canada.

Aged↗
PubMed1999

Insurance coverage for prescription drugs: effects on use and expenditures in the Medicare population.

BACKGROUND: Although most of the elderly are covered by Medicare, they potentially face large out-of-pocket costs for their health care because of excluded services. Aside from nursing home care, the exclusion of prescription drugs is one of the most significant. Several earlier policy initiatives have proposed adding prescription drug coverage to the Medicare program. To determine the effects of such an expansion, one must account for the potential increase in the demand for prescription drugs from providing insurance coverage. METHODS: The study uses a new data source, the RAND Elderly Health Supplement to the 1990 Panel Study of Income Dynamics (PSID). The endogenity of insurance coverage is tested using instruments that exploit the longitudinal nature of the data. Equations are estimated on 910 persons (> or = 66 years) using a two-part model. RESULTS: Insurance coverage for prescription drugs significantly increases the probability of use, but not of total expenditures, among those who use prescription drugs. However, insurance coverage significantly lowers out-of-pocket expenditures, thereby decreasing the financial burden on elderly households associated with prescription drug use. Medicaid coverage has effects that are smaller than those for private insurance, but the magnitude is less precisely estimated. These findings imply that if prescription drug coverage were added to Medicare, expected expenditures on drugs would rise by on average $83 for each elderly Medicare beneficiary (in 1990 dollars), although this increase is significant only at the 90% level. If the benefit had been included under Medicare, expected spending on prescription drugs by the elderly would have risen by approximately 20%, or $2.6 billion in 1990.

Aged↗
PubMed2004

Feasibility of optimizing the dose distribution in lung tumors using fluorine-18-fluorodeoxyglucose positron emission tomography and single photon emission computed tomography guided dose prescriptions.

The information provided by functional images may be used to guide radiotherapy planning by identifying regions that require higher radiation dose. In this work we investigate the dosimetric feasibility of delivering dose to lung tumors in proportion to the fluorine-18-fluorodeoxyglucose activity distribution from positron emission tomography (FDG-PET). The rationale for delivering dose in proportion to the tumor FDG-PET activity distribution is based on studies showing that FDG uptake is correlated to tumor cell proliferation rate, which is shown to imply that this dose delivery strategy is theoretically capable of providing the same duration of local control at all voxels in tumor. Target dose delivery was constrained by single photon emission computed tomography (SPECT) maps of normal lung perfusion, which restricted irradiation of highly perfused lung and imposed dose-function constraints. Dose-volume constraints were imposed on all other critical structures. All dose-volume/function constraints were considered to be soft, i.e., critical structure doses corresponding to volume/function constraint levels were minimized while satisfying the target prescription, thus permitting critical structure doses to minimally exceed dose constraint levels. An intensity modulation optimization methodology was developed to deliver this radiation, and applied to two lung cancer patients. Dosimetric feasibility was assessed by comparing spatially normalized dose-volume histograms from the nonuniform dose prescription (FDG-PET proportional) to those from a uniform dose prescription with equivalent tumor integral dose. In both patients, the optimization was capable of delivering the nonuniform target prescription with the same ease as the uniform target prescription, despite SPECT restrictions that effectively diverted dose from high to low perfused normal lung. In one patient, both prescriptions incurred similar critical structure dosages, below dose-volume/function limits. However, in the other patient, critical structure dosage from the nonuniform dose prescription exceeded dose-volume/function limits, and greatly exceeded that from the uniform dose prescription. Strict compliance to dose-volume/ function limits would entail reducing dose proportionality to the FDG-PET activity distribution, thereby theoretically reducing the duration of local control. Thus, even though it appears feasible to tailor lung tumor dose to the FDG-PET activity distribution, despite SPECT restrictions, strict adherence to dose-volume/function limits could compromise the effectiveness of functional image guided radiotherapy.

Algorithms↗
PubMed2006

Factors predicting the guideline compliant supply (or non-supply) of non-prescription medicines in the community pharmacy setting.

BACKGROUND: The reclassification of prescription only medicines to pharmacy and general sales list medicines (also known as non-prescription medicines) provides the public with greater access to medicines that they can purchase for self-care. There is evidence that non-prescription medicines may be associated with inappropriate supply. This study investigated factors predicting evidence-based (guideline compliant) supply or non-supply of non-prescription medicines. METHOD: Secondary analysis of results from a randomised controlled trial of educational interventions to promote the evidence based supply of non-prescription medicines. Ten actors made simulated patient (customer) visits to 60 community pharmacies using seven scenarios reflecting different types of presentations. The dependent variable was appropriate (guideline compliant) supply of antifungal medication for treatment of vaginal candidiasis. RESULTS: No significant association was shown between guideline compliant behaviour and pharmacy type or location, or with the actor making the visit. The likelihood of guideline compliant outcome was significantly greater with symptom presentations than with condition or product presentations (p < 0.001). The likelihood of a guideline compliant outcome increased (a) as more information was exchanged (p < 0.001), (b) with the use of WWHAM (a mnemonic frequently used by medicine counter assistants during consultations for non-prescription medicines) (p < 0.001); (c) when specific WWHAM questions were used (including "description of symptoms" (p < 0.001) and "whether other medication was currently being used" (p < 0.001); and (d) in consultations involving solely pharmacists compared with those involving only medicine counter assistants (p = 0.017). After adjustment for presentation type, a significant association persisted between appropriate outcome and consultations with WWHAM scores of 2 and > or = 3, respectively. CONCLUSIONS: The nature and extent of information exchange between pharmacy staff and customers has a strong influence on the guideline compliant supply of non-prescription medicines. Future interventions to promote the safe and effective use of non-prescription medicines should address the apparent deficit in communication between pharmacy staff in general, and medicine counter assistants in particular, which may reflect both pharmacy staff skills and customer expectations.

Adult↗
PubMed2004

Psychotropic prescriptions and elderly suicide rates.

Suicide rates in the elderly have declined in recent years in several countries including England and Wales. There have also been major changes in prescribing patterns of psychotropics in many countries during recent years. This study examined the association between a trend of decline in suicide rates in the elderly in England and Wales and changes in the prescribing of psychotropics for the period 1985 to 1996. Data on suicide rates was ascertained from the annual mortality statistics for the years 1985 to 1996. Data on the prescriptions of psychotropics was ascertained from the Statistic Division (SD1E) at the Department of Health. Spearman's rank correlation coefficient (rho) was used to examine the relationship between the prescription of psychotropics and suicide rates. The main findings of this study were: (i) a highly significant negative correlation between the prescription of tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) and elderly suicide rates; (ii) a significant positive correlation between the prescription of monoamine oxidase inhibitors (MAOIs) and elderly suicide rates; (iii) a highly significant negative correlation between the prescription of antimanics and antipsychotics and elderly suicide rates; (iv) a highly significant positive correlation between the prescription of hypnotics, anxiolytics and barbiturates and elderly suicide rates; and, (v) a significant negative correlation between the prescription of analgesics and elderly suicide rates. A trend of decline in suicide rates in the elderly in England and Wales for 1985 to 1996 and changes in the prescribing of psychotropics were significantly associated. The results of this study suggest that prescription patterns of psychotropics may be an important factor contributing to the recent decline in suicide rates in the elderly in England and Wales but this effect should be viewed in the context of other health and social factors.

Aged↗
PubMedDate not supplied

Impact of an evidence-based computerized decision support system on primary care prescription costs.

PURPOSE: Although newer, heavily promoted medications are commonly prescribed, published evidence and consensus guidelines often support the use of less expensive alternatives. This study was designed to evaluate the impact on prescription costs of a computerized decision support system (CDSS) that provides evidence-based recommendations to clinicians during the electronic prescribing process. METHODS: A retrospective cohort study was performed using a pharmacy claims database. Clinicians using the CDSS were matched with a control group by pharmacy billed amount, number of patients treated, and number of new prescriptions filled during a 6-month baseline period in which neither group used the system. The primary outcome measure was the difference in prescription costs between the 2 groups after implementation of the CDSS in the intervention group. RESULTS: Clinicians who received evidence-based messages had significantly lower prescription costs than those in the control group. The average cost per new prescription was 4.16 dollars lower (P = .02) in the intervention group, and the average cost for new and refilled prescriptions was 4.99 dollars lower (P = .01). The 6-month savings from new prescriptions and their refills are estimated to be 3,450 dollars (95% CI, 1,030-5,863 dollars) per clinician. CONCLUSIONS: Providing electronic, evidence-based decision support during the prescribing process can shift prescribing decisions toward more evidence-based care and significantly decrease primary care prescription costs.

Analysis of Variance↗
PubMed2006

Prescription drug abuse information in D.A.R.E.

This investigation was designed to examine prescription drug-related content and learning objectives in Drug Abuse Resistance Education (D.A.R.E.) for upper elementary and middle schools. Specific prescription-drug topics and context associated with content and objectives were coded. The coding system for topics included 126 topics organized within 14 categories. A two-dimensional coding system for context identified Use versus Abuse and Explicit versus Implicit references to prescription drugs. Results indicated that content and objectives found in D.A.R.E. represent a very narrow breadth of prescription drug topics. Moreover, all prescription-drug related content and objectives were presented in an Abuse-Implicit context. Although some educational material in D.A.R.E. modules potentially is related to prescription drugs, none of the content or objectives explicitly identify drugs discussed as prescription drugs. If elementary and middle schools rely on D.A.R.E. modules to teach students about drug abuse, students are likely to be underinformed about prescription drug risks.

Adolescent↗
PubMed2003

[Impact of medical prescription computerisation on the incidence of adverse drug effects].

INTRODUCTION: Adverse drug effects are a significant public health problem. Prescription errors are responsible for a significant proportion of these adverse effects. METHODS: We have aimed to improve the link between generation of and interpretation of a prescription through computerisation. The prescription sheet, which is generated daily, was organised to allow care planning without the need to re-copy out treatments on the sheet. A prescription aid was available which was based on a core group of drugs commonly used in our respiratory service. The aim of the study was to compare the various types of errors observed during 6 weeks of computerized prescriptions (229 files) to a retrospective series of handwritten prescriptions of the service at an identical time (184 files) the previous year. The case-mix was identical for both analysed periods. RESULTS: The total number of technical prescribing errors in the 1,599 handwritten lines (49.27% error) was significantly higher (p<0.001) than the 1,805 computerized prescriptions lines (42.88% error). The errors of copying (p<0.001), eligibility (p<0.001) and incorrect spelling (p<0.05) were the main sources of error which were significantly reduced by computerisation. CONCLUSION: Computerised prescription is likely to reduce the incidence of prescribing errors and adverse drug effects.

Clinical Pharmacy Information Systems↗
PubMedDate not supplied

Evolution of nutritional therapy prescription in critically ill patients.

AIM: The aim of this study was to investigate factors that may affect the evolution of the caloric prescription in critically ill patients. Local: Intensive care unit patients. PATIENTS: 60 patients (33 M and 27 F); median age = 49 (1593) y were followed prospectively. They were divided in three groups according to the diagnostic: (a) trauma (n=20); (b) surgical (n=22), and 3) medical treatment (n=18). Forty-and-one (68.3%) patients received enteral nutrition (EN), 17 (28.3%) parenteral nutrition (TPN), and 2 (3.4%) TNP and EN. Nutritional status was graded B or C by global subjective evaluation. METHODS: Endpoints of the study were the time to begin the nutritional support, success or failure of the caloric prescription, and the evolution of the planned caloric prescription. The caloric evolution was considered as success if the prescription for the patient attained: (a) 25% of the caloric requirements on the 1st day; (b) 50% until the 3rd day; (c) 75% until the 6th day; and (e) 100% until the 10th day of the beginning of the support. RESULTS: In 54 (90%) patients, the nutritional support has begun until 48 h after admission and in 73.3% (44 patients), until the first 24 hours. EN was most prescribed for both trauma and medical patients while NPT was most used for surgical patients (p < 0.01). Success in caloric prescription was obtained in 73.3% (44) of the patients. There was no statistical difference for the success on the evolution of the prescription related to sex, age, diagnostic group, albumin level, type of support, mortality, use of fiber or glutamine. Success was attained earlier in patients without (median = 3.8 [95% CI, 5.7-16.7] days) than with (11.2 [95% CI, 5.7-16.7] days; p < 0.01) mechanical ventilation. CONCLUSIONS: Early nutritional support and success on the evolution of the caloric prescription can be accomplished in most critically ill patients. Evolution of the caloric prescription was slower in mechanical ventilated patients.

Adolescent↗
PubMed1989

Psychotropic drug prescription in Italy. A survey in general practice.

A survey of psychotropic drug prescription was conducted in Verona using information obtained from 92 GPs. A total of 2559 patients consulted their GPs on the day of the study and 14.2% of them received a prescription for a psychotropic drug. Benzodiazepines were the most frequently prescribed: 72.8% and 70.4% of all psychotropic prescriptions in women and men respectively. The prevalence of prescription was higher in women than in men (15.8% vs 11.2%) and the difference was statistically significant (P less than 0.001). Subjects aged 45-64 had the highest chance of receiving prescriptions for psychotropics. Occupational status seems related to psychotropic drug prescription only in women. A strong association was found between psychotropic drug prescription and conspicuous psychiatric morbidity. This association was independent of sex, age, and occupational status. An interactive effect between social problems and sex on psychotropic drug prescription was found. The perception by the GP of a social problem increases the risk that a psychotropic will be prescribed about twice in women, but not in men.

Adolescent↗
PubMed1988

Prescription of benzodiazepines in general practice in the county of Arhus, Denmark.

During one week in 1985, 227 general practitioners in the County of Arhus, Denmark, recorded their prescriptions of benzodiazepines. In all 2,812 prescriptions were recorded, for 2,574 patients. The sex ratio (male/female) was 1.0/2.0. The incidence of first-time prescriptions was 26.0 prescriptions/1,000 inhabitants/year. The prescription rate, calculated as defined daily doses/1,000 inhabitants/day, was highest for minor tranquillizers in the age group 60-69, whereas for hypnotics/sedatives it was highest in the age group 70+. Of minor tranquillizers, 83-84% were prescribed as anxiolytics, and of hypnotics/sedatives, 98% were prescribed as hypnotics. Only 18-28% of patients had a diagnosis of psychiatric illness. Between 62-75% of patients received no other treatment than a benzodiazepine prescription. At the time of the first prescriptions, 44-57% of the patients were mentally distressed. For about 33% of patients, a somatic illness was of essential importance for the prescription. Twenty-six percent of the men and 17% of the women taking benzodiazepines were recognized as real or potential abusers. Eighty-three percent of repeat prescriptions were prescribed through indirect contacts.

Adolescent↗